What will New York’s pandemic response look like in the future?

Catastrophes often spur change in government. The 9/11 attacks led to the creation of the U.S. Department of Homeland Security and an expanded investment in combatting terrorism among local police departments, especially the NYPD. Hurricane Sandy’s destructive impact pushed New York City to dedicate billions of dollars to new climate resiliency projects to prepare for other natural disasters. 

Unlike terrorist attacks and natural disasters, the COVID-19 pandemic has hit the entire country and will continue to do so until a working vaccine is developed. This is especially true of New York, which has seen the worst outbreak of COVID-19 thus far. Such a far-reaching health crisis will likely end up changing the way the state and localities will prepare for emergencies in the future.

“The pandemic is going to fundamentally change responsibilities in a lot of different areas,” said Robert Griffin, dean of the College of Emergency Preparedness, Homeland Security and Cybersecurity at the University of Albany. “Chiefly among them is that both businesses and government agencies are going to have to have a much more robust program for both planning and response to a whole set of disasters.”

Whether that means the creation of new government agencies in state and local government dedicated to pandemics – as some have speculated could happen on a federal level – or smaller-scale changes is up in the air. Some operational changes are naturally already happening as the state and New York City have had to adjust rapidly to the coronavirus outbreak. Under normal circumstances, for example, it would’ve been difficult to imagine the city would appoint a “director of isolation.”

To figure out the best strategies, policy makers will need to examine what worked this time – and what didn’t. Disasters are often followed by after-action reports, which outline the successes and failures about how governments responded. 

This could serve as a valuable tool for informing future approaches – but it can often go awry. “Too often with the after-action reports, they are sanitized by the time they get to a place where they’re distributed and they’re not as candid as they need to be,” said David Abramson, a professor at New York University’s School of Global Public Health. They often can be politicized or treated as fodder for lawsuits, Griffin said, noting they’ve become “punitive rather than educational.” 

But if elected officials in New York commit to honestly reviewing their work, they can learn best practices for future emergencies – and that need for reflection may become more pressing given that health officials are anticipating more coronavirus outbreaks in the near future. Many lessons have already emerged. 

Building greater hospital capacity would be vital to ensuring New York hospitals don’t get so quickly overwhelmed by new cases again, health and disaster relief experts said. And though the state largely followed its previously established pandemic response plan, experts are recommending that future social distancing measures are implemented more swiftly given what happened during the initial COVID-19 outbreak. If lockdown measures had been implemented just one week earlier in New York City, about 14,700 fewer people would’ve died from COVID-19 as of May, according to research from Columbia University. Improved data sharing and other capacity-building measures for health care systems are also recommended by any health experts. 

And it’s important not just to make changes as they relate to immediate needs during the pandemic, but to think about long-term, consistent investments into the health system. 

“It’s tempting to think about that capacity we’re building now as just a temporary thing we need now,” said Glen Mays, an expert in health systems at the Colorado School of Public Health, “and eventually we may not need it once we get over the hump of the pandemic.” But the expansion of contact tracing, for example, and other public health resources could be helpful for the future, he said, allowing “a robust public health system capability on an ongoing basis to detect and even prevent future health threats going forward.”

Responsiveness to pandemics relies on more than just the public health system. Widespread outbreaks at nursing homes, fueled by a lack of personal protective equipment, understaffing and a state-level directive that mandated long-term care facilities let in residents recovering from COVID-19, and technological difficulties and learning gaps resulting from school closures, highlight the need to prepare plans for other institutions, Griffin said.

A more collaborative approach, involving different government agencies, may be key to doing that. “One of the areas of vulnerability that have really been exposed is the limited ability of our sectors to best align and collaborate across traditional sectors of medical care, public health and social services broadly defined,” Mays said, noting that local and state government can be particularly well-suited to facilitating that collaboration. 

New structures such as task forces or interagency councils may be a good idea to do that, May said. Griffin also recommended that preparedness professionals be embedded more deeply in the administrations of governors and mayors in the future. “We're seeing that across the country that they can't be sort of a secondary thought,” Griffin said. “They have to be part of the inner circle.” 

Experience from previous disasters point to mixed results regarding how radically government improves vulnerabilities. Major crises such as the 9/11 attacks have led to oversight committees in Congress that produce major policy changes and congressional leaders have floated the creation of a similar commission regarding the coronavirus response. The House of Representatives has already voted to establish a new investigative body to do just that, though that effort may be hampered by Republicans who fear embarrassing President Donald Trump. 

But changes or improvements that officials implement may falter years after the fact. For example, public health funding at a federal level was boosted in the aftermath of 9/11, but took a hit during the 2008 financial crisis and hasn’t fully recovered since. That trend is partially driven by competing demands for government funding that don’t dissipate in the aftermath of a disaster, which could be a particularly difficult issue for lawmakers today who are contending with shrinking budgets and economic needs among constituents suffering from the effects of the coronavirus-induced recession. 

Some might even say the process is cyclical. “I have no doubt we’re going to make similar mistakes again,” said Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University.